<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user.user/index" data-field="username" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Vip_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-vip_id" data-rule="required" data-source="vip/index" class="form-control selectpage" name="row[vip_id]" type="text" value="{$row.vip_id}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Vip_info')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-vip_info" data-rule="required" class="form-control " rows="5" name="row[vip_info]" cols="50" disabled>{$row.vip_info}</textarea>
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Vip_sn')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-vip_sn" data-rule="required" class="form-control" step="0.01" name="row[vip_sn]" type="number" value="{$row.vip_sn}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-price" data-rule="required" class="form-control" step="0.01" name="row[price]" type="number" value="{$row.price}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} disabled /> {$vo}</label>
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="payStatusList" item="vo"}
            <label for="row[pay_status]-{$key}"><input id="row[pay_status]-{$key}" name="row[pay_status]" type="radio" value="{$key}" {in name="key" value="$row.pay_status"}checked{/in} disabled /> {$vo}</label>
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[pay_time]" type="text" value="{:$row.pay_time?datetime($row.pay_time):''}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-pay_type" data-rule="required" class="form-control selectpicker" name="row[pay_type]" disabled>
                {foreach name="payTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.pay_type"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Platform_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-platform_type" data-rule="required" class="form-control selectpicker" name="row[platform_type]" disabled>
                {foreach name="platformTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.platform_type"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Expire_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-expire_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[expire_time]" type="text" value="{:$row.expire_time?datetime($row.expire_time):''}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ward_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ward_last" data-rule="required" class="form-control" name="row[ward_last]" type="number" value="{$row.ward_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Surgery_ward_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-surgery_ward_last" data-rule="required" class="form-control" name="row[surgery_ward_last]" type="number" value="{$row.surgery_ward_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Special_ward_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-special_ward_last" data-rule="required" class="form-control" name="row[special_ward_last]" type="number" value="{$row.special_ward_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Escort_vip_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-escort_vip_last" data-rule="required" class="form-control" name="row[escort_vip_last]" type="number" value="{$row.escort_vip_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Escort_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-escort_last" data-rule="required" class="form-control" name="row[escort_last]" type="number" value="{$row.escort_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Escort_halfday_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-escort_halfday_last" data-rule="required" class="form-control" name="row[escort_halfday_last]" type="number" value="{$row.escort_halfday_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Register_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-register_last" data-rule="required" class="form-control" name="row[register_last]" type="number" value="{$row.register_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Inquiry_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-inquiry_last" data-rule="required" class="form-control" name="row[inquiry_last]" type="number" value="{$row.inquiry_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Document_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-document_last" data-rule="required" class="form-control" name="row[document_last]" type="number" value="{$row.document_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicine_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicine_last" data-rule="required" class="form-control" name="row[medicine_last]" type="number" value="{$row.medicine_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Records_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-records_last" data-rule="required" class="form-control" name="row[records_last]" type="number" value="{$row.records_last}" disabled>
        </div>
    </div>
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Escort_overtime_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-escort_overtime_last" data-rule="required" class="form-control" name="row[escort_overtime_last]" type="number" value="{$row.escort_overtime_last}" disabled>
        </div>
    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Severe_illness_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-severe_illness_last" data-rule="required" class="form-control" name="row[severe_illness_last]" type="number" value="{$row.severe_illness_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Oversea_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-oversea_last" data-rule="required" class="form-control" name="row[oversea_last]" type="number" value="{$row.oversea_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Private_doctor_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-private_doctor_last" data-rule="required" class="form-control" name="row[private_doctor_last]" type="number" value="{$row.private_doctor_last}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Famous_doctor_last')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-famous_doctor_last" data-rule="required" class="form-control" name="row[famous_doctor_last]" type="number" value="{$row.famous_doctor_last}" disabled>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
